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BMC Musculoskeletal Disorders

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Open Access 01-12-2018 | Research article

Influence of the site of acromioplasty on reduction of the critical shoulder angle (CSA) – an anatomical study

Authors: Dominik Kaiser, Elias Bachmann, Christian Gerber, Dominik C. Meyer

Published in: BMC Musculoskeletal Disorders | Issue 1/2018

Abstract

Background

A large critical shoulder angle (CSA) >35° is associated with the development of rotator cuff tearing. Lateral acromioplasty (AP) has the theoretical potential to prevent rotator cuff tearing and/ or to reduce the risk of re-tears after repair. It is, however unclear which part of the lateral acromion has to be reduced to obtain the desired CSA. It was the purpose of this study to determine which part of the lateral acromion has to be resected to achieve a desired reduction of the CSA in a given individual.

Methods

First, the influence of the exact radiographic projection on the CSA was examined. Second, the influence of anterolateral versus strict lateral AP on the CSA was studied in eight scapulae with different anatomic characteristics. Differences in CSA reduction were investigated using paired t-test or Wilcoxon test.

Results

Scapular rotation in the sagittal and axial plane had a marked influence on the radiologically measured CSA ranging from -6 to +16°. Overall, lateral AP of 5/10mm reduced the CSA significantly greater than anterolateral AP of 5mm/10mm [5mm: 2.3° (range: 0.7°-3.6°) SD±0.8° vs. 1.2° (range: 0°-3.3°) SD±1.1°, p=0.0002]/[10mm: 4.8° (range: 2.1°-7°) SD±1.3° vs. 2.7° (range: 0°-5.3°) SD±1.7°, p=0.0001]. Depending on scapular anatomy anterolateral AP did not alter CSA at all.

Conclusions

For comparison of pre- and postoperative CSA, the exact orientation of the X-ray and the spatial orientation of the scapula must be as identical as possible. Anterolateral AP may not sufficiently correct CSA in scapulae with great acromial slopes and smaller relative external rotation of the acromion as the critical acromial point (CAP) may be located too posteriorly and thus is not addressed by anterolateral acromioplasty. Consistent reduction of the CSA could be achieved by lateral AP in all eight scapulae.

Bigliani LU, Morrison DS, April EW. The morphology of the acromion and its relationship to rotator cuff tears. Orthop Trans. 1986;10:228.

Hamid N, Omid R, Yamaguchi K, Steger-May K, Stobbs G, Kenner JD. Relationship of radiographic acromial characteristics and rotator cuff disease: a prospective investigation of clinical, radiographic, and sonographic findings. J Shoulder Elbow Surg. 2012;2:1289–98.CrossRef

Oh JH, Kim JY, Lee HK, Choi JA. Classification and clinical significance of acromial spur in rotator cuff tear. Clin Orthop Relat Res. 2010;468:1542–50.CrossRef

Balke M, Liem D, Greshake O, et al. Differences in acromial morphology of shoulders in patients with degenerative and traumatic supraspinatus tendon tears. Knee Surg Sports Traumatol Arthrosc. 2016;24:2200–5.CrossRef

Balke M, Schmidt C, Dedy N, Banerjee M, Bouillon B, Liem D. Correlation of acromial morphology with impingement syndrome and rotator cuff tears. Acta Orthop. 2013;84(2):178–83.CrossRef

Moor BK, Wieser K, Slankamenac K, Gerber C, Bouaicha S. Relationship of individual scapular anatomy and degenerative rotator cuff tears. J Shoulder Elbow Surg. 2014;23:536–41.CrossRef

Nyffeler RW, Werner CM, Sukthankar A, Schmid MR, Gerber C. Association of a large lateral extension of the acromion with rotator cuff tears. J Bone Joint Surg Am. 2006;88(4):800–5.PubMed

Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg. 2010;19(1):116–20.CrossRef

Yamamoto A, Takagishi K, Kobayashi T, Shitara H, Ichinose T, Takasawa E, et al. The impact of faulty posture on rotator cuff tears with and without symptoms. J Shoulder Elbow Surg. 2014;24(3):446–52.CrossRef

10.

Moor BK, Bouaicha S, Rothenfluh DA, Sukthankar A, Gerber C. Is there an association between the individual anatomy of the scapula and the development of rotator cuff tears or osteoarthritis of the glenohumeral joint? A radiological study of the critical shoulder angle. Bone Joint J. 2013;95-B:935–41.CrossRef

11.

Suter T, Gerber Popp A, Zhang Y, Zhang C, Tashjian RZ, Henninger HB. The influence of radiographic viewing perspective and demographics on the critical shoulder angle. J Shoulder Elbow Surg. 2015;24:e149–58.CrossRef

12.

Katthagen JC, Marchetti DC, Tahal DS, Turnbull TL, Millett PJ. The effects of arthroscopic lateral acromioplasty on the critical shoulder angle and the anterolateral deltoid origin: an anatomic cadaveric study. Arthroscopy. 2016;32(4):569–75.CrossRef

13.

Karns MR, Jacxens M, Uffmann WJ, Todd DC, Henninger HB, Burks RT. The critical acromial point: the anatomic location of the lateral acromion in the critical shoulder angle. J Shoulder Elbow Surg. 2018;27(1):151–9.CrossRef

14.

Banas MP, Miller RJ, Totterman S. Relationship between the lateral acromion angle and rotator cuff disease. J Shoulder Elbow Surg. 1995;4(6):454–61.CrossRef

15.

Gerber C, Catanzaro S, Betz M, Ernstbrunner L. Arthroscopic Correction of the Critical Shoulder Angle Through Lateral Acromioplasty: A Safe Adjunct to Rotator Cuff Repair. Arthroscopy. 2018;34(3):771–80.CrossRef

16.

Beeler S, Hasler A, Götschi T, Meyer DC, Gerber C. The Critical Shoulder Angle: Acromial Coverage is More Relevant than Glenoid Inclination. J Orthop Res. 2018. https://doi.org/10.1002/jor.24053.

17.

Garcia GH, Liu JN, Degen RM, Johnson CC, Wong A, Dines DM, Gulotta LW, Dines JS. Higher critical shoulder angle increases the risk of retear after rotator cuff repair. J Shoulder Elbow Surg. 2016;26(2):241–5.CrossRef

18.

Hong L, Chen Y, Chen J, Hua Y, Chen S. Large Critical Shoulder Angle Has Higher Risk of Tendon Retear After Arthroscopic Rotator Cuff Repair. Am J Sport Med. 2018;46(8):1892–900.CrossRef

Title: Influence of the site of acromioplasty on reduction of the critical shoulder angle (CSA) – an anatomical study
Authors: Dominik Kaiser
Elias Bachmann
Christian Gerber
Dominik C. Meyer
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Musculoskeletal Disorders / Issue 1/2018
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-018-2294-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Influence of the site of acromioplasty on reduction of the critical shoulder angle (CSA) – an anatomical study

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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